Lymphedema is swelling of the arm, hand, or chest wall caused by a build-up of lymph fluid in tissue after surgery, especially surgery that removes underarm (axillary) lymph nodes. (Edema is the medical term for swelling.) A study suggests that lymphedema may be more common and last longer than generally thought. The study also suggests that the risk of lymphedema can last 5 years or more after breast cancer treatment ends.
Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues near the surgery site. The more lymph nodes that are removed, the greater the risk of lymphedema. Some research suggests that the risk of lymphedema is higher and any lymphedema that does develop is more severe in women who are overweight or obese. Radiation therapy and chemotherapy can increase the risk of lymphedema.
The researchers monitored 211 breast cancer survivors for 5 years, looking for symptoms of lymphedema. They used four ways to decide if a woman had lymphedema.
Five years after surgery, 43% to 94% were judged to have lymphedema. The percentages varied because the four methods of diagnosing lymphedema had different criteria. Still, this range is much higher than the 15% to 20% risk that is considered average lymphedema risk.
The percentage of women with lymphedema was:
- 94% based on arm circumference (anywhere on the arm) change of more than 2 cm. (about 0.75 inches)
- 83% based on three-dimensional arm volume increase of 200 ml (6.5 ounces) or more; this increase is called limb volume change (LVC)
- 55% based on LVC increase of 10% or more
- 43% based on a woman reporting lymphedema symptoms; in addition to swelling of the soft tissues of the arm or hand, other lymphedema symptoms are numbness, a feeling of heaviness in the limb, or pain
Many women first developed lymphedema more than a year after surgery; some women developed lymphedema 5 years after surgery. The results contradict conventional wisdom that lymphedema generally develops during the first year after surgery. The researchers are continuing to analyze the results, hoping to identify the factors linked to lymphedema development long after surgery.
These results suggest that lymphedema after breast cancer surgery is more common than doctors realize and that lymphedema can happen years after treatment.
If you're getting ready to have breast cancer surgery, be sure to ask your doctor about your risk of lymphedema and the steps you can take to lower that risk. If you've already had surgery and now have lymphedema, you probably already know ways to help manage lymphedema, including:
- elastic sleeves and/or gloves to gently compress tissue and move out excess fluid
- decongestive therapy, in which a specially trained therapist gently massages the affected skin and tissue; the arm is usually bandaged between the massages
You can learn more about how to minimize the risk of lymphedema as well as other ways manage it in the Breastcancer.org Lymphedema section.